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Want to know which are the most suicidal cities in the U.S.? According to information provided by the Centers for Disease Control (CDC), in the United States, more Americans die of suicide than from car accidents. This disturbing statistic accounts for the profound problems in the country, which some are not able to cope with or overcome. In fact, suicide is the 12th leading cause of death in America, behind cardiovascular disease and cancer. If you’re interested in a more global approach, check out our list of the 20 Most Depressed and Suicidal Countries in the World.

Usually, suicide is closely related to mental disorders and environmental stressors. This major cause of death in the U.S. is not easy to research; many even believe that the figures of suicide rate are not very accurate, as it is sometimes very difficult to state whether a death was accidental, homicidal or suicidal. Among the environmental factors associated with suicide you can find some of the following at the top: bullying, economic decline, depression, anxiety, financial stress, widespread availability of opioid drugs, unemployment and natural disasters.

Suicide rates have risen sharply in the last decade across all geographic areas and states. The jump escaped no one; in fact, the most pronounced increase was seen among middle-aged men, a group highly affected by economic setbacks like recession.

In compiling our list we used the data published by the National Association of County and City Health Officials and City Data. If you are curious about the most suicidal cities in the U.S, take a look at the countdown.

10. Pittsburgh, Pennsylvania

Annual rate:15.2 per 100,000 people annually

Pittsburgh’s crime index is 440.7, much higher than the national average of 279.

9. Jacksonville, Florida

Annual rate: 15.6 per 100,000 people annually

Despite being located in the Sunshine State, Jacksonville is in the top ten of most suicidal cities. From 1990 to 2004, there was a 16.3% change in the city’s suicide rates. Suicide related factors in Jacksonville include unemployment and crime index.

8. Denver, Colorado

Annual rate: 16.2 per 100,000 people annually

According to the Denver Post, suicide rates peaked in 2009 with 940 reported in Colorado. From 2005 to 2009, suicide rates in Denver were closely linked to job loss, bankruptcy, eviction and other economic factors.

7. Miami, Florida

Annual rate: 17.1 per 100,000 people annually

Having another city from Florida State in our countdown shows that sunshine is no guarantee for happiness. The cost of living, unemployment and crime account for the suicides in Miami.

6. Mesa, Arizona

Annual rate: 19.6 per 100,000 people annually

According to the Arizona Suicide Prevention Alert, there were 784 reported cases of suicides in 2002 which is 300% higher than the national average.

We continue the somber task of counting down America’s most suicidal cities on the next page.